Director, Managed Care
The Director of Managed Care Contracting is a motivated self-starter who works well in deadline-driven environments. Responsible for evaluating, negotiating and monitoring contracts for services rendered by hospital-based providers in the Emergency Medicine, Hospital Medicine and Anesthesia specialties with a wide variety of commercial and managed care organizations. Manages the overall contracting process including price negotiation, contract implementation, escalator maintenance, and communication to billing department groups. Resolves complex operational issues by communicating directly with counterparts at commercial and managed care organizations.
Basic responsibilities include:
- Works independently to negotiate and write contracts with a wide variety of commercial and managed care organizations. Experience with value based and bundled reimbursement arrangements.
- Serves as a subject matter specialist and consultant to operations and development with respect to pricing managed care markets and activities therein.
- Responsible for development, interpretation, implementation and maintenance of contracts.
- Establishes rapport and maintains working relationships with current and potential managed care organizations.
- Drives the overall managed care contracting process, including distributions, updates to contract rates, maintenance of electronic contract files and rate databases feeding reimbursement systems.
- Executes fee schedule and contract analysis through usage of the reimbursement system, strong excel and other analytical skills. Manages appeals process.
- Assembles data and provides reports, conducts research as necessary and remains abreast of current and emerging issues related to national, state and local health care market, contracting practices, and/or government rules and regulations.
- Performs miscellaneous projects as requested.
Required Skills and Qualifications:
- Bachelor’s Degree and 5 to 7 years minimum experience directly related to the duties and responsibilities of this position
- CPAR – Certified Patient Account Representative Preferred
- Strong background and understanding of Stark Law, Anti-Kickback Statute and False Claims Act
- Strong background and understanding of network billing and billing legislation
- Strong background in and ability to aggressively negotiate managed care and commercial contracts
- Ability to identify and mitigate departmental and institutional risks
- Strong background in negotiating reimbursement rates for the professional fee component of provider reimbursement
- Strong foundation in value based reimbursement
- Knowledge of government healthcare regulations
- Excellent verbal and written communication skills
- Analytical and problem solving skills, strong excel skills
- Ability to work independently to resolve issues
- Ability to manage multiple projects simultaneously
- Ability to provide responsive customer service to operations and follow through
- Ability to prioritize and organize projects to meet deadlines
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